RA Messages for June 17, 2003

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PHARMACY PROVIDERS

EFFECTIVE MAY 30, 2003, DENY CLAIM FACSIMILES WILL NO LONGER BE GENERATED AND MAILED WITH THE RA TO PHARMACY PROVIDERS FOR THE FOLLOWING POS DENY EDIT CODES:

485 - PA REQUIRED
486 - RA EXPIRED
498 - NO OF RX GREATER THAN LIMIT
575 - MISSING OR INVALID ICD-9 CODE
576 - MISSING OR INVALID PA/MC CODE

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ATTENTION HOME AND COMMUNITY-BASED WAIVER SERVICES PROVIDERS

FOR INFORMATION ABOUT HOME AND COMMUNITY-BASED WAIVER SERVICES AS AN 
ALTERNATIVE LONG TERM CARE OPTION, PLEASE CALL 1-800-660-0488.

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DISCONTINUATION OF WHEELCHAIR SEATING EVALUATION CODE

EFFECTIVE SEPTEMBER 1, 2003, PROCEDURE CODE Y7902 FOR WHEELCHAIR SEATING EVALUATION WILL BE PUT IN NON-PAY STATUS. PROVIDERS OF THIS SERVICE MUST USE PROCEDURE CODE Y7702 IS A PHYSICAL THERAPIST DOES THE EVALUATION, AND PROCEDURE CODE Y7812 IF AN OCCUPATIONAL THERAPIST DOES THE EVALUATION. THE PHYSICAL THERAPY EVALUATION  IS REIMBURSED AT THE RATE OF $54.00 AND THE OCCUPATIONAL THERAPY EVALUATION IS REIMBURSED AT THE RATE OF $51.00.  WHEN BILLING FOR THESE SERVICES, PROVIDERS MUST SUBMIT A PRESCRIPTION FROM A PHYSICIAN IN ORDER TO RECEIVE REIMBURSEMENT.

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ATTENTION LTC AND HOME HEALTH PROVIDERS

WITH HIPAA IMPLEMENTATION, LTC AND HOME HEALTH PROVIDERS WILL BEGIN BILLING CLAIMS USING THE UB-92 CLAIM FORM OR THE 837I ELECTRONIC INTERCHANGE (EDI) TRANSACTION.  IN AN EFFORT TO ALLOW PROVIDERS, SOFTWARE VENDORS, BILLING AGENTS, AND CLEARINGHOUSES (VBCS) AN ADVANCE OPPORTUNITY TO REVIEW INSTRUCTION FOR BILLING THE UB-92 HARD COPY CLAIM FORM AND SPECIFICATIONS FOR THE 837I TRANSACTION PRIOR TO THE IMPLEMENTATION THESE DOCUMENTS ARE COMPLETE AND AVAILABLE UPON REQUEST.  THE UB-92 INSTRUCTIONS ARE IN "DRAFT" FORM AT THIS TIME AWAITING FINAL APPROVAL.  TO OBTAIN A COPY OF THE UB-92 BILLING INSTRUCTIONS, PROVIDERS SHOULD CONTACT UNISYS PROVIDER RELATIONS AT 800-473-2783 OR 225-924-5040.  VBCS MAY VIEW/OBTAIN THE UB-92 INSTRUCTIONS OR THE 837I EDI COMPANION GUIDE BY ENROLLING IN OUR HIPAA TESTING ENVIRONMENT WHERE THE DOCUMENTS WILL BE AVAILABLE FOR DOWNLOAD.  THE HIPAA TESTING SERVICE ENROLLMENT  FORM IS AVAILABLE FOR DOWNLOAD AT WWW.LAMEDICAID.COM/HIPAA OR IT CAN BE REQUESTED BY EMAILING THE HIPAA EDI GROUP AT *HIPAAEDI@UNISYS.COM (NOTE: * IS PART OF THE EMAIL ADDRESS) OR BY CALLING 1-225-237-3318.